Maria M. Wertli, MD
The Spine Journal
Available online 7 March 2014
In Press
Abstract
Background Context
Psychological factors including catastrophizing thoughts are believed to influence the development of chronic low back pain.
Purpose
To assess the prognostic importance of catastrophizing as a coping strategy in patients with low back pain.
Study Design
Systematic Review
Patient Sample
Patients with low back pain.
Outcome Measures
Work related outcomes and perceived measures including return to work, pain and disability.
Methods
In September 2012, the following databases were searched: BIOSIS, CINAHL, Cochrane Library, Embase, OTSeeker, PeDRO, PsycInfo, Medline, Scopus, and Web of Science. To ensure completeness of the search, a hand search and a search of bibliographies was conducted and all relevant references included. All observational studies investigating the prognostic value of catastrophizing in patients with low back pain were eligible. Included were studies with 100 and more patients and follow-up of at least three months. Excluded were studies with poor methodological quality, short follow-up duration, and small sample size. This study was not funded and the authors have no conflict of interest to declare.
Results
1473 references were retrieved, and 706 references remained after the removal of duplicates. For 77 references, the full text was assessed and 19 publications based on 16 studies were included. Of four studies that investigated work-related outcomes, two found catastrophizing to be associated with work status. Most studies that investigated self-reported outcome measures (n= 8, 66%) found catastrophizing to be associated with pain and disability at follow-up in acute, subacute, and chronic low back pain patients. In most studies that applied cut-off values, patients identified as high catastrophizers experienced a worse outcome compared to low catastrophizers (n=5, 83%).
Conclusion
There is some evidence that catastrophizing as a coping strategy might lead to delayed recovery. The influence of catastrophizing in patients with low back pain is not fully established and should be further investigated. Of particular importance is the establishment of cut-off levels for identifying patients at risk.